Evidence-based Surgical Management of Post-acne Scarring in Skin of Color

Acne scars are the reason for significant morbidity among dermatology outpatients. With more modalities being introduced every year, it is important to choose the best one suited for a particular type of scar for each patient to obtain an optimum result. Guidelines on acne scar management in the skin of color are not available where the therapeutic effect and side effect profile of the modalities can vary significantly. This narrative review looked at critical evaluation of the available modalities to find the level of evidence and therapeutic ladder of management of different types of acne scars. Treatment options for different types of scars have been described. Evidence level for each type of modality for the individual type of scar was calculated using the Strength of Recommendation Taxonomy (SORT) developed by editors of the US family medicine and primary care journals. In addition, various newer and emerging treatment options, such as dermal cell suspension, jet volumetric remodeling, and radiofrequency subcision, have been discussed. The highest level of evidence is available for microneedling, fractional radiofrequency, fractional CO(2), and erbium:yttrium aluminum garnet laser for mild to moderate grade scars. Trichloroacetic acid chemical reconstruction of skin scars showed efficacy in ice pick scars. Grade 4 scars improve poorly with resurfacing procedures, where punch excision and punch elevation can be tried. Platelet-rich plasma therapy was effective in combination with lasers and microneedling. Overall there is lack of high-quality data in the management of post acne scars. Combination treatment has shown better efficacy compared to single modalities.